Journal of investigative medicine : the official publication of the American Federation for Clinical Research
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Randomized Controlled Trial
ANKK1/DRD2 locus variants are associated with rimonabant efficacy in aiding smoking cessation: pilot data.
Polymorphism of the DRD2 gene (rs1800497), previously termed Taq1A, includes the A1 and A2 alleles. The A1⁺ genotype (A1/A1, A1/A2) has been associated with smoking dependence. The present study determined which polymorphism of the DRD2 gene had a salutary outcome in administration of rimonabant, a drug used in smoking cessation and obesity studies. ⋯ These findings further support the rationale for incorporating genotyping into clinical trials, particularly smoking cessation trials. Rimonabant demonstrated early and sustained smoking cessation efficacy only in noncarriers of the A1 allele. These results also underscore the risks of heterogeneity contributing to type 2 errors, when analyzing (phase 2 or 3) data. The potential clinical, regulatory, and commercial benefits associated with expediting and enhancing drug development, vis-à-vis the integration of biomarkers in clinical research, is supported by our findings.
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Renal dysfunction is a common and potentially life-threatening complication in hospitalized patients with cirrhosis. ⋯ Both AKI and CKD are common in hospitalized patients with cirrhosis, often occurring simultaneously. Type 2 HRS was not identified, suggesting that its diagnostic criteria may need reevaluation or that this syndrome may not represent a unique functional kidney disorder.
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Variable treatment exists for children with bacterial pneumonia complications such as pleural effusion and empyema. Subspecialists at an urban academic tertiary children's hospital created a literature-based diagnosis and management algorithm for complicated pneumonia in children. We proposed that algorithm implementation would reduce use of computed tomography (CT) for diagnosis of pleural infection, thereby decreasing radiation exposure, without increased adverse outcomes. ⋯ Implementation of an institutional complicated pneumonia management algorithm reduced CT scan use/radiation exposure, VATS procedures, and readmission rate in children with a diagnosis of pleural infection, without associated increases in length of stay or vancomycin use. This algorithm provides the framework for future prospective quality improvement studies in pediatric patients with complicated pneumonia.
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There is a dearth of literature about the safety and practicality of intubation performed by an internal medicine (IM) or any other nonanesthesia, nonemergency physician. ⋯ Procedurally oriented IM fellows could provide a temporary solution to hospitals that currently do not have the resources to provide full-time, in-house anesthesiology or emergency physicians for management of the emergent airway.
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Advanced glycation end products (AGEs) and the interaction with their receptors (RAGE) play an important role in the pathogenesis of diabetic foot (DF) associated with diabetic neuropathy. Our study examined the association between asymmetric dimethyl arginine (ADMA), fructosamine, nitric oxide (NO), and soluble (s) RAGE levels in serum of diabetic patients with and without neuropathy. ⋯ Soluble forms of the receptor for advanced glycation end product could be an endogenous protection factor against occurrence of DF, hence may be of therapeutic value in the treatment of DF.